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Ligation of hemorrhoids with latex rings is a relatively new technique that is in demand among patients around the world. It is resorted to if treatment by conservative methods has not borne fruit.
The technique works great as a gentle alternative to surgery, as it is a minimally invasive format of care. The only significant drawback here is the inability to use latex rings at the most advanced stages of the development of the pathology of hemorrhoids.
Many victims like the method because it provides outpatient treatment. After the device is installed, the patient is allowed to go home under personal responsibility. The course of rehabilitation after surgery is less time than is usually required after surgery.
The price of manipulation completely depends on the stage at which the hemorrhoids are located, the individual characteristics of the person who applied, as well as the manufacturer who creates the rings.
Indications for use
The principle of ligation is based on the experience of problem areas with special devices. Due to the fact that blood can no longer flow into the lesion, over time it ceases to receive enough nutrients. After a week or two, it is rejected by the body as an unnecessary element.
Rings for fixing the knot are made of a special material that somewhat resembles rubber, and at the same time does not contain harmful components. This is what guarantees the absence of an allergic reaction after installation. The only exception may be some rare anomaly with individual intolerance, but this is extremely rare.
The main indications for issuing a referral for ligation are a confirmed ailment in stages 2 or 3, provided that it is an internal type. With this degree of education, they have large forms, since they have already managed to form, while delivering unpleasant sensations to their owner. A person suffers from itching, burning in the anus, pain during prolonged sitting, bleeding.
Manipulation allows you to extinguish unpleasant symptoms, as well as eradicate the source of problems in order to reduce the risk of relapse.
An additional advantage of ligation is the absence of the need to perform classical general anesthesia, which negatively affects the cardiovascular activity of patients. Local anesthesia has a more gentle effect on the operated tissues. But even for her, you still have to conduct an allergic test, so that later you do not face the consequences in the form of anaphylactic shock.
Separately, the proctologist is obliged to take into account the presence of contraindications for the applicant. They are identified at the stage of preliminary examination. Relative and absolute prohibitions include:
- the first stage of hemorrhoids, since during this period the node has not yet formed sufficiently for its correct extraction;
- a combined form of the disease, which provides for the absence of a pronounced border between adjacent neoplasms;
- diagnosed anal fissures;
- chronic course of paraproctitis;
- inflammatory processes at their peak.
Another contraindication, but relative, is called the fourth stage of the disease. Everything here is purely individual. But at the first stage of the disease, it will be possible to cope with the help of ointments, baths, gels and suppositories. But even they should be prescribed by an experienced professional after the victim has undergone a clinical examination.
Preparation period
In order for the planned therapeutic event to go according to plan, you will need to spend time on thorough preparation. In addition to undergoing clinical trials, the patient must stop taking medications designed to reduce blood clotting in advance.
But before abandoning a previously approved therapy program, you must first consult with a narrow specialist who prescribed the course. It is likely that a person only needs to drink pharmacological agents for a couple of weeks to successfully complete the treatment. Then it will be more productive to wait, and only then go for ligation.
On the evening before the appointed date, you will need to empty your intestines as much as possible. For this, a cleansing enema or special laxative pharmacy solutions are useful. The list of the latter, dosage, instructions for use should be checked with the proctologist in advance.
If the victim is being treated in a specialized clinic in an inpatient department, then he may be offered hydrocolonotherapy before the operation. The procedure is aimed at painless bowel movements. Such discretion allows you to block the appearance of a chair before the allowed time.
The essence of the technique
Numerous reviews of satisfied patients confirm the effectiveness of the method. But those who have not yet decided to conduct ligation do not always fully understand the essence of such assistance.
When the node is squeezed with a ring, it stops receiving nutrients, I atrophy in about a week. And here a fair question arises in the victims, where then the fallen off process goes along with the latex sheath. They come out naturally in the process of natural defecation, which does not cause significant inconvenience.
To install the “cap” of the desired size, the doctor first uses an anoscope. With its help, it turns out to inspect the affected tissues, as well as to capture the knot in a ring, in order to then pull its source of nutrient intake. After blocking the access of blood, followed by drying of the problematic growth, a small scar is formed at the site of the press.
So that for two weeks, while the node is blocked, but not yet removed, the person is as comfortable as possible, the surgeon will definitely ask how tightly the loop is tightened. If the pain is especially strong, then it is recommended to use anesthetic injections directly into the node itself to stop the discomfort.
When he confirms that the victim has several neoplasms, he will have to come to the proctologist several times.
This is explained by following the ligation protocol, where overlapping of more than two nodes in one run is prohibited. Instead, the manipulation is carried out in stages to exclude possible complications in the future. The break between sets should be at least a month.
Classification of ligators
There are two types of ligators in proctology: mechanical and vacuum. Each of them has its own disadvantages and positive qualities. Regardless of the chosen strategy, the victim will still have to climb onto a special chair.
In the mechanical version, he is seated sideways, or laid on his back, asked to pull his legs up to his stomach. An anoscope is first inserted into the rectum. Due to such a device, it turns out to fix the hole so that the lesion itself is visible in the lumen.
A mechanical device is inserted into the anoscope itself, and then, using a soft clamp, the knot is pulled back to retract it into the head of the ligator. When removed from the trigger of the device, the ligature is dropped onto the leg of the node, which implies the girth of the base without capturing the nearest tissues. Accuracy at this stage helps not to touch the healthy layers.
Doctors prefer to use the mechanical format of the device, if necessary, to excise internal nodes that have clear edges and a pronounced leg. In total, the treatment event takes about ten minutes, and people with a high pain threshold are generally offered to refuse even local anesthesia.
A slightly different principle operates a vacuum analogue, which also has to be inserted through an anoscope. Only now it is still connected to the suction, which is necessary to generate negative pressure.
As soon as the suction is turned on, the surgeon must close the hole in the head of the ligator with his finger. The measure is aimed at ensuring that the hemorrhoid is retracted inward. After the negative pressure reaches 0,7-0,8 atmospheres, the doctor activates the trigger. Two rings are dropped onto the leg, after which the finger is removed from the hole and the pressure in the head of the ligator is equalized so that it is equal to the external pressure.
If you skip this stage, then the knot can come off ahead of time, provoking extensive bleeding. Upon completion of the manipulation, the ligator is removed.
It is believed that vacuum adaptation is better suited for work, since it does not require the presence of an assistant. The advantage of the method is added by the fact that it is allowed to resort to it if the knot leg is poorly expressed, and the boundaries of the growth are difficult to determine.
Both cases involve the use of the same elastic rings based on natural latex. Their outer girth diameter is 5 mm, and only 1 mm inside.
Due to the elastic structure, the device reliably squeezes the nodal pedicle, blocking the flow of blood. If the patient has found especially large single formations, then it would be more logical to break their removal into several sessions, keeping about a month between each approach. The phased scheme is great for giant pathologies that cannot be covered with a ring in one grab.
It is necessary to prepare for the fact that even such a sparing non-invasive technique has a rehabilitation period. During recovery, a person may periodically experience a feeling of having a foreign body in the anus, as well as a pain syndrome.
You can remove it with analgesics, which the doctor will prescribe during the consultation, taking into account the individual characteristics of each of his wards.
Are complications possible?
The first few days after ligation of the process are the most important. If the victim has mild pain, then this is quite normal, but with severe pain, you should consult a doctor. There is a possibility that the ligature was applied incorrectly. The same sensations are experienced by those people who have undergone ligation of several nodules at once.
The most common type of complication is thrombosis of external nodes. A similar rule applies to those victims who were diagnosed with a combined form of the disease. This means that the lesions do not have clear boundaries between the internal and external components.
In such a scenario, due to circumstances, it is impossible to do without a course of conservative therapy. But only a proctologist should also prescribe medications, with an eye to the current state of the ward. Rectal bleeding is much less common. The reason for this is the rupture of the latex ring, or its tension is too strong.
Occasionally, the opposite principle leads to the same aftereffects – an incorrectly selected knot size to support the established ligature. This will become a catalyst for his jumping off with sharp attempts. Also, bleeding will make itself felt if the patient went against medical recommendations, deciding:
- engage in active sports;
- lift weights;
- empty the bowels according to the rules;
- ignore advice on personal hygiene;
- do not follow dietary restrictions.
In order not to experience bleeding during the first bowel movement, you will need to first cleanse the intestines. You will also have to try to avoid bowel movements on the first day by eating only something liquid like broth, juice, yogurt.
In the following days, doctors insist that patients still soften the stool by eating the right food. It should contain vegetable fibers and fiber. You also need to carefully monitor your own drinking regimen.
To heal faster, it is worth giving up sitting in a sitting position for a long time, and also work on the prevention of constipation.
Some complications are a direct consequence of exposure to infection. With a similar development of the scenario, a person has pain, weakness, fever, and problematic urination.
If you find these signs in yourself, you should immediately consult a doctor to take emergency measures to counter the spread of infection.
Advantages and disadvantages
According to statistics, in 80% of clinical cases, ligation allows you to achieve and consolidate a long-term positive effect. At the same time, you will not have to spend twice as much time on rehabilitation, as well as suffer from extensive scarring. When using latex rings, the trace remains only at the place of the clamp, which makes it possible to less traumatize the surrounding still healthy tissues.
After spending approximately 15 minutes, the patient can go home immediately after the ring is placed, especially without limiting himself in daily activities. During surgery, you have to stay in the hospital for several days under the supervision of medical personnel.
The disadvantages of the measure include the feeling of discomfort that is felt due to the introduced device. You also need to be prepared for the fact that during the exit of the dead node, slight bleeding is possible, but this is also quite normal. The first stool will be a little problematic, but otherwise the bowel movement will go smoothly. To reduce the risks of discomfort, you must follow the rules voiced by the proctologist.